An article at psychologytoday.com by Hara Estroff Marano states that insomnia is experienced by up to 80% of depressed individuals. Depression sufferers may have difficulty in falling sleep, may wake up early and be unable to return to sleep, or they may sleep fitfully. Marano explains, however, that it is not just a matter of getting less sleep, but that “the makeup of their sleep is shattered.”
Normal sleep is composed of cycles of varying “stages,” which are marked by specific brain wave activity. At WebMD.com we learn that there are two basic states of sleep: REM (rapid eye movement) sleep and NREM (non-rapid eye movement) sleep. NREM consists of four stages, moving from drowsiness to light sleep to deeper sleep. During the deep sleep stages, reparation and regeneration of body tissues occur, and the body works to replenish neurotransmitters essential to mental wellbeing.
NREM sleep is typically followed by a shorter period of REM sleep during which dreams generally occur. The body continues to cycle between NREM and REM sleep throughout the night.
Normally, the first episode of REM sleep occurs about 90 minutes into sleep. Depressed individuals, however, move into REM sleep very quickly and an excessive amount of time spent in REM sleep decreases the amount of NREM time when the body would normally be under repair. Additionally, Marano indicates that this rushed stage of REM, for depressed people is “unusual both in duration and intensity, more dense, intense and longer-lasting,” and may cause an “overconsolidation of negative memory” leading to a bias for remembering negative things, and the failure to “discharge negative feelings over time.”
There is evidence that just as depression can contribute to insomnia, insomnia can likewise lead to depression. So good sleep is critical to both recovery from and prevention of depression.
There are a number of steps that can be taken to help with better sleep. Here are some suggestions:
** Have a regular sleep schedule. Try to go to bed and wake up at the same time each day. Don’t try to compensate for bad sleep by going to bed early or sleeping in late. Do not take naps during the day.
** Exercise daily, but not within a few hours before going to bed.
** Make the bed as comfortable as possible and use it only for sleep or sex. Don’t read or watch TV while lying in bed. You want the bed to be a cue for sleeping, not lying awake.
** Keep the bedroom cool, quiet and dark. Use blackout shades or eye masks if necessary, and ear plugs or a white noise machine to diminish sound disruptions.
** Avoid caffeine in the afternoon and evening, and avoid stimulating or energizing activity just before bedtime (i.e. internet, television, intense conversations…). Develop a calming pre-sleep ritual, such as a warm shower, meditation and/or listening to soft music.
If you find yourself lying awake and ruminating over concerns, make a list before you go to bed of your concerns or of actions that you need to take the following day. Then try to put those thoughts aside until the next day. Try relaxation techniques such as abdominal breathing, or scanning the body for tension and consciously releasing it. Notice intrusive thoughts, and then allow them to pass without trying to analyze or judge them. Be gentle with yourself and don’t try to force sleep.
If you are unable to get to sleep after lying in bed for 20-30 minutes, get up and go to another room or a different part of the bedroom and do some calm, soothing and boring activity until you feel drowsy. Then return to bed. Repeat as many times as necessary.
If insomnia persists, your doctor may be able to prescribe medication to assist you in sleeping. When you consult your doctor, be sure to mention any non-prescription remedies you may be using.
Hopefully some of these suggestions will help if you are suffering from insomnia. Still to come in our series of the “basics”: relaxation, journaling, reaching out and affirmations.